HomeMy WebLinkAboutBLD2022-01534 - BLD CD Environmental Health Review - 12/13/2022 ,
/`,,s06''''-'SSSst�l MASON COUNTY COMMUNITY SERVICES Permit No:0/A2R0 2 015 m
PERMIT ASSISTANCE CENTER: r- vi—I^
tf • •,`?,. •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL —
�� )• 0 615 W.Alder Street,Shelton,WA 98584 g "' L
D Z1 /
.t, f"" I Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone ry [
�it� .1'," Belfair::(360)275-4467•Phone Elma:(360)482-5269 DEC 1 3 2022 7� �\
17
j"'•ttt•�.r:"�^ 615 W. Alder Street \�
BUILDING PERMIT APPLICATIOI>$15 W. Alder Street
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: h/7'4/1 KA,-�/;y 7) _ NAME ENVIRONMENTAL
• MAILING ADDRESS 7-—Z 4' )e(')//,..).?, MAILING ADDKh SS:
CITY, 5Aee/fa/1_ STATE: /-L� ZIP: 7 CITY, STATE: HEM TTHPHONE#1: _23 - , 32i/C��?-e_') 7 PHONE!.: . rZL:
PHONE#2: EMAIL :�
EMAIL: !4/7C-Ic�}//'lnti-6,)ey.'Ytc ji/: - =frf L&I REG#_ EXP. ,
PRIMARY CONTACT: OWNERS CONTRACTOR❑ OTIFIER 0 /i • Le_c__-wl.NAME / , 7/Ln /ZIA r i/7 / �/ EMAIL 1/- I)(X'L( /'J CL' J�c/��,Y.ill MAILING ADDRESS. _K2'S' A&-t/A-; £• , CITYI / STATE ,/ ZIP�Iyi2
PHONE CELL_ -',;-,37.23/ ` �} ) 7
PARCEL INFORMATION:
�ll
PARCEL NUMBER(12 Digit Number) ���>ri '"_7C.._J - k) �J ZONING
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT
SITE ADDRESS r�2 sal , - - -4 I /el . /CITY 34"-- �� '5/f 1�
- DIRECTIONS TO SITE ADDRESS,...3-- /7-y, ice_ ,>t 9 f A e f 4-, -—j
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO, SNOW LOAD:2S psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER ❑ LAKE 0 RIVER/CREEK 0 POND 0 WETLAND 0 SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEW 0 ADDITION 0 ALTERATION ❑ REPAIR 0 OTHER 0
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.
IS USE: PRIMARY ❑ SEASONAL❑ NUMBER OF BEDROOMS , NUMBER OF BATHROOMS C
HEATED STRUCTURE? YES(Whole Bldg) 0 YES(Part[s]ofBldg) 0 NO 0
DESCRIBE WORK
SQUARE FOOTAGE: (proposed)
1ST FLOOR sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq. ft. BASEMENT sq. ft.
DECK sq. ft. COVERED DECK sq. ft. STORAGE sq.ft. OTHER sq. ft.
GARAGE sq.ft. Attached❑ Detached❑ CARPORT sq.ft. Attached❑ Detached 0
MANUFACTURED HOME INFORMAT N: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE i L�S/G/n 1. MODEL U•:Z/ 'SC.J 1'EAR.g(,..,2 LENGTH&
/ C 7
WIDTII 76--, /y i� BEDROOMS , _J BATI-IS �� SERIAL NUMBER f �) Z i5
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC,,' SEWER 0 / NEW 0 EXISTING,
PLUMBING IN STRUCTURE? YES R NO 0 If yes, attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 (2NOR EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS 2 TOTAL BEDROOMS 3
OWNER acknowledges that submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is by
signature below.I declare that I am the owner and I further declare that I am entitled to receive this permit and to do the work as proposed.I have
obtained permission from all the necessary parties,including any easement holder or parties of interest regarding this project. The owner or legal
representative,represents that the information provided is accurate and grants employees of Mason County access to the above described property
and structure(s)for review and inspection. This permit/application becomes null&void if work or authorized construction is not commenced within 180
days or if construction work is suspended for a period of 180 days.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT P1 If ION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED. (MASON
\- COUNTY CODE 14.08.42)
x c)cam. 9 ae
Signature of 0 R(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL � M
PUBLIC HEALTH 42- yI -Ain (J\i (�1`,,Ci3 Q44-(2,),
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